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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2021.tde-06122021-143202
Document
Author
Full name
Ana Letícia Gomide Zanin Borducchi
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Santana, Rodrigo de Carvalho (President)
Coêlho, Harnôldo Colares
Souza, Fernanda Fernandes
Vilar, Fernando Crivelenti
Title in Portuguese
Avaliação da eficácia, tolerabilidade e desenvolvimento de resistência com o uso dos antivirais de ação direta no tratamento da hepatite C em indivíduos infectados pelo HIV
Keywords in Portuguese
Coinfecção
DAA
HCV
HIV
Abstract in Portuguese
A hepatite crônica pelo vírus C (HCC) é uma importante causa de morbimortalidade nos pacientes coinfectados com vírus da imunodeficiência humana (HIV), sendo a principal causa de óbito não relacionada ao HIV nesses pacientes. Os novos fármacos antivirais de ação direta (DAA) revolucionaram a história natural da HCC, pois aumentaram as chances de cura. O estudo se propôs a avaliar a eficácia, tolerabilidade e desenvolvimento de genes de resistência com o uso dos DAA para tratamento do vírus da hepatite C (HCV) nos pacientes com HIV. Trata-se de um estudo observacional prospectivo que avaliou 112 pacientes em seguimento no ambulatório de coinfecção de um serviço de nível terciário. Destes, 93,75% eram genótipo 1 do HCV, 51,35% nunca tinham recebido medicação, somente 62,50% tiveram adesão completa ao acompanhamento, e apenas 24,10% da população estudada tinha cirrose, 100% tinham antirretrovirais (ARV) prescritos, com média de linfócitos T CD4+ de 655 cél/ul, e 91,96% tinham carga viral do HIV indetectável. Os efeitos colaterais foram mais frequentes durante o primeiro mês do tratamento e no grupo que usou Ribavirina (RBV), sendo que os sintomas mais relatados foram: cefaleia, astenia, e náuseas, respectivamente. O sinal/alteração de exame mais frequente foi redução da hemoglobina, sendo que 100% dos casos ocorreram no grupo que usou RBV. 100% dos pacientes que fizeram uso da medicação e coletaram carga viral do HCV (RNA-HCV) 24 semanas após término do tratamento persistiram com carga viral indetectável, não possibilitando, portanto, a pesquisa de genes de resistência às medicações.
Title in English
Evaluation of the efficacy, tolerability and development of resistance with the use of direct-acting antivirals in the treatment of hepatitis C in HIV-infected individuals
Keywords in English
Co-infection
DAA
HCV
HIV
Abstract in English
The chronic liver disease caused by the hepatitis C virus is an important cause of morbidity and mortality at people are coinfected with human immunodeficiency virus (HIV), being the main cause of death not related to HIV in these patients. The new direct-acting antiviral drugs (DAA) had revolutionized the natural history of chronic hepatitis C virus (HCC) because they increased the chance of a cure. The study aimed to evaluate the efficacy, tolerability and development of resistance genes with the use of direct-acting antivirals for the treatment of hepatitis C in patients with HIV. This is a prospective observational study that evaluated 112 patients being followed up in the coinfection outpatient clinic of a tertiary level service. Of these, 93.75% were HCV genotype 1, 51.35% had never received medication before, only 62.50% had complete adherence to follow-up, and only 24.10% of the studied population had cirrhosis, 100% had prescribed antiretroviral therapy, with a mean CD4 T lymphocytes of 655 cells/ul, and 91.96% had undetectable viral load. Side effects were more frequent during the first month of treatment and in the group that used Ribavirin (RBV), with the most reported symptoms being: headache, asthenia, and nausea, respectively. The most frequent signal/change was reduction in hemoglobin, with 100% of cases occurring in the group that used RBV. 100% of the patients who used that medication and collected HCV viral load (RNA-HCV) 24 weeks after the end of treatment persisted with an undetectable viral load, thus not making it possible to search for drugs resistance genes.
 
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Publishing Date
2022-01-07
 
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